Medicare and Cosmetic Surgery: What’s Covered?

If you are a Medicare beneficiary and you are interested in getting cosmetic surgery, you should know that not all forms of cosmetic surgery are covered by Medicare. In short, Medicare will cover the cosmetic surgeries that are considered “necessary.” This means Medicare does not cover any cosmetic surgery that isn’t needed to better your quality of life.

The three main types of cosmetic surgeries that Medicare will cover are surgeries due to an accidental injury, a malformed body part, and a mastectomy.

Cosmetic Surgery Medicare Coverage for Accidental Injuries

Accidental injuries are caused by anything that is out of someone’s control. For example, being in a car accident could be considered an accidental injury. This can result in burns, a broken nose, and much more. Any cosmetic surgery needed after an accident will be covered by Medicare.

Cosmetic Surgery Coverage for Malformed Body Parts

Cosmetic surgery may be needed to correct malformed body parts. Malformed body parts can be caused by numerous things, but a few that occur most often are cause by birth defects, diseases, and traumas.

If cosmetic surgery is needed to improve a malformed body part that resulted from one of the above causes, then Medicare will likely cover it.

Medicare Coverage for Breast Reconstruction

If you have to have a lumpectomy or mastectomy because of breast cancer, you may have questions about breast reconstruction. Breast implants are internal protheses and will, of course, require additional surgery. Other breast protheses include post-surgical bras. These are external protheses and do not require any additional surgery after you have the mastectomy.

Not all cosmetic surgeries have the same patient status. For instance, breast reconstruction options can include either inpatient or outpatient surgery. Either way, Medicare will cover it. If you elect to have external protheses, Medicare will cover that as well.

Which Part of Medicare Pays?

Original Medicare consists of two parts: Part A and Part B. Each part is responsible for different items of a cosmetic surgery. Part A covers your inpatient hospital stay, inpatient surgeries, skilled nursing and some home health care immediately after a hospital stay. Part B covers outpatient surgeries and almost everything needed after you leave the hospital.

For accidental injuries, Part A will cover the cosmetic surgeries during an inpatient stay. If your injuries require braces or additional treatment after being released from the hospital, those items will also be covered by Part B. These same rules apply for cosmetic surgery for malformed body parts.

The part of Original Medicare that covers your breast protheses all depends on which type of protheses you choose. Since internal protheses require surgery, Part A will cover it. Part B will cover the external forms of breast protheses.

There are cost-sharing amounts predetermined for each part of Medicare. For example, Part B pays 80% of the bill, while you are responsible for 20%. However, if you have a plan that covers those gaps in Original Medicare, you may not have to worry about paying that 20%.

If you do not have additional coverage within your Medicare, it’s important you learn what type of deductibles and copays you will need to pay for each part of your cosmetic surgery. Paying 20% of the bill may not seem like a lot, but in the case of an outpatient surgery, it could be a lot. Cosmetic surgery can end up costing you a very pretty penny if you don’t have additional coverage, such as a Medigap plan, to help you cover deductibles, coinsurance and copays.